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Following chronic damage, collagen is deposited in the liver, due to activation of hepatic stellate cells into hepatic myofibroblasts, blocking blood flow through the liver.
- B (Hepatitis B)
- C (Hepatitis C)
- Autoimmune - PBC, AIH, PSC
- Biliary obstruction - biliary atresia, CF
- Copper in Wilson's disease and other metabolic disoders (haemochromatosis, a-1AT deficiency)
- Drugs - methotrexate, amiodarone, isoniazid
- Biopsy is gold standard, but not always needed
- Deranged LFTs - raised transaminases and raised g-GT if active alcoholic; hypoalbuminaemia in advanced cirrhosis
- Raised PTT
- Hyponatraemia – due to raised ADH and aldosterone
- FBC: Thrombocytopaenia – due to splenomegaly; macrocytosis - alcohol abuse
- Viral screen, ferritin and transferrin, autoantibody screen, a-1AT, ceruloplasmin - for causes
- USS/MRI/CT can also be used, looking at the liver, as well as spleen.
- Spider naevae
- Palmar erythema
- Dupytrens contracture
- Portal hypertension
- Portal hypertension - porto-systemic shunting which may cause acute variceal bleeding
- Ascites - a transudate. Take a sample of ascetic fluid to identify cause and exclude SBP (see below. Treated with dietary salt and fluid restriction and diuretics. If resistant or intractable - treat with therapeutic paracentesis.
- Spontaneous bacterial Peritonitis – peritonitis without any obvious source of infection. Occurs in patients with portal hypertension. Hepatic encephalopathy, abdo pain, and ileus are common symptoms. PMN count >250cells/mm3 in ascitic fluid. First line treatment is tazocin
- Hepatic encephalopathy - precipitated by build up of ammonia, benzodiazepines or cytokines. Treated by managing precipitating factors and regular lactulose
- Hepatorenal syndrome – rapid deterioration of renal function in absence of other idenfiable cause in individuals with cirrhosis/liver failure due to arterial vasodilation and decreased cardiac output causing regional arterial vasoconstriction.
- Hepatopulmonary syndrome – SOB and low p02 due to vasodilation (and fall in BP) in lungs of patient with cirrhosis/liver failure. Worse when sitting upright.